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$3,278 ER Visit for Coughing Fits and Fever Amid Covid-19 Pandemic Highlights Failure of For-Profit System

"Congress and insurers have made all of these promises to waive copays for treatment and testing but we're hearing that's not always the reality."

Healthcare for People Not Profit sign

Polling published in April 2020 found that 69% of Americans support Medicare for All. (Photo: Elvert Barnes/flickr/cc)

A $3,278 bill that Timothy Regan received after coughing fits and a low-grade fever sent him to a Denver emergency room in early April—as the number of confirmed Covid-19 cases in the United States continued to climb—garnered national media attention Monday as an example of how much the nation's for-profit healthcare system is costing Americans, particularly in the midst of the coronavirus pandemic.

Regan and Kaiser Health News editor-in-chief Elisabeth Rosenthal appeared on "CBS This Morning" to discuss the four-figure bill from Denver Health and the fact that his insurance provider, UnitedHealthcare, initially only covered $1,042, leaving Regan's family with $2,236 to pay—even though a law passed by Congress requires insurers to fully cover Covid-19 testing and many companies, including UnitedHealthcare, are also waiving treatment costs.

As the segment and a report from KHN explained, UnitedHealthcare's initial limited coverage resulted from how Denver Health coded Regan's ER visit. Although Regan was presumed positive for Covid-19 by a doctor, he didn't receive a nasal swab test for the virus; Denver Health told "CBS This Morning" that it was complying with testing guidelines from the Centers for Disease Control and Prevention, and Regan didn't qualify.

"The Regans said they initially found no satisfaction in calling the hospital or the insurer to resolve their dispute―but it was the right thing to do," according to KHN. Ultimately, UnitedHealthcare reviewed the claims at the request of KHN and concluded that Regan's ER trip should have been coded as related to Covid-19 and covered in full, so "all cost share for that visit has been waived," a spokesperson for the insurer said.

Despite the insurance company's ultimate reversal in Regan's case, "he's definitely not alone" in being hit with surprise bills related to Covid-19, Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms, told KHN. "The takeaway here is both the provider as well as insurance company are still on a learning curve with respect to this virus and how to bill and pay for it."

Rosenthal echoed that sentiment in the "CBS This Morning" segment, which noted that the Families First Coronavirus Response Act enacted by Congress in March requires insurers to cover all the costs of diagnosing Covid-19 without imposing any cost-sharing requirements, including deductibles, copayments, and coinsurance—and many private insurers have voluntarily expanded that policy to related treatment.

"Congress and insurers have made all of these promises to waive copays for treatment and testing but we're hearing that's not always the reality," Rosenthal said broadly, before addressing Regan's visit. "So what happens is, in his case, no one wrote 'Covid-19' on the coding, right, so that when the insurer is processing the bill, they don't see Covid-19 code, so they think, 'oh, just an ER visit.'"

"Now, there's plenty of blame to go around here," she added. "Sometimes we feel like it's intentional, sometimes an oversight, and it's often hard to know, because an insurer can in some ways rightfully push back and say: 'Oh, that was just an ER evaluation'; 'Well, he didn't have Covid'; or 'There was no Covid test done.'"

Such claims from insurers—which can result in massive bills for patients, as millions of Americans have recently lost jobs and therefore their employer-provided health insurance due to the public health crisis—are "just not right," said Rosenthal, and strike her as "breaking promises."

Corlette emphasized the importance of insurers covering coronavirus treatment in her interview with KHN:

Insurers' moves to waive costs associated with Covid testing and related treatment is vital to stemming the outbreak—but it works only if patients can trust they won't get stuck with a large bill, she said. "It's a critical piece of the public health strategy to beat this disease," Corlette said.

To help with billing, she said, patients could ask their provider to note on their medical chart when they are seeking care for possible Covid-19. But it's not the patient's responsibility to make sure providers use the right billing code, she said. Patients need to know they have the right to appeal costs to their insurer. They can also seek assistance from their employer's benefits department and state insurance department.

Some advocates and policymakers have gone even further in response problems with Covid-19 testing, treatment, and billing. Longtime single-payer advocates Sen. Bernie Sanders (I-Vt.) and Rep. Pramila Jayapal (D-Wash.) have introduced the Health Care Emergency Guarantee Act (pdf) to use Medicare to cover all out-of-pocket health costs for everyone in the country during the pandemic.

That proposal is an alternative to a healthcare provision in the $3 trillion Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act introduced by House Democratic leadership and passed by the lower chamber. The provision would effectively subsidizes COBRA, an existing program that allows laid-off and furloughed workers to pay to temporarily stay on their employer-provided plan.

"COBRA subsidies prop up the health insurance industry while leaving families in the lurch," Physicians for a National Health Program president Dr. Adam Gaffney said in a statement earlier this month. "In the long run, we need Medicare for All to provide full health protections for Americans. But the Health Care Emergency Guarantee Act could ensure protection for American families today."

Polling published by The Hill in late April revealed that U.S. public support for a single-payer healthcare system has remained strong over the past two years. Among registered voters across the political spectrum, 69% said they support providing Medicare to every American. Broken down by political party affiliation, 88% of Democrats, 68% of Independents, and 46% of Republicans said they support Medicare for All.

"These progressive policies have been popular for a long time," Felicia Wong, president and CEO of the Roosevelt Institute, told Hill.TV at the time. " I think Covid-19 will make them more popular as it becomes clear just how fragile our American political economy really is."

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